Provider Demographics
NPI:1306955398
Name:MORMAN, MARK BRADLEY (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:BRADLEY
Last Name:MORMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8250 CAROLINE ST, UNIT 1702
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004
Mailing Address - Country:US
Mailing Address - Phone:713-898-9695
Mailing Address - Fax:
Practice Address - Street 1:2750 S 8TH ST BLDG A
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-7719
Practice Address - Country:US
Practice Address - Phone:409-839-1032
Practice Address - Fax:409-839-1069
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ43762084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044305302Medicaid
TXF91003Medicare UPIN
TXP00122460Medicare PIN
TX044305302Medicaid